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NPI Code Detail

MEDICARE: VAUGHN D TATUM M.D.

MEDICARE: VAUGHN D TATUM M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician036-056693IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841309994
Entity Type Code : Individual
Provider Name (Legal Business Name) : VAUGHN D TATUM M.D.
Provider Business Mailing Address
First Line : 4085 CREEKVIEW RIDGE DR
Second Line :
City : BUFORD
State : GA
Zip : 30518-8743
Country : US
Telephone Number : 773-587-2616
Fax Number :
Provider Business Practice Location Address
First Line : 1834 CLAIRMONT RD # 100
Second Line :
City : DECATUR
State : GA
Zip : 30033-3405
Country : US
Telephone Number : 404-634-4443
Fax Number : 708-848-5270
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 09/18/2020

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Directions to “ VAUGHN D TATUM M.D.” Practice Location

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